283 e-Letters

  • Promoting resilience among physicians is not an effective way to tackle burnout.

    In recent times, a lot has been spoken about the concept of ‘promoting physician resilience’ to tackle burnout.(1)(2) However, since the definitions and the strategies of resilience revolve around intrinsic factors, there is skepticism about this concept.(3) Now that the focus is being shifted towards the external factors influencing the burnout, this systematic review by Fox et al redefines ‘resilience’ in order to incorporate these external determinants into the domain of resilience.(4) While this letter agrees with the views portrayed by the authors of the review, it additionally discusses certain drawbacks of stressing the promotion of physician resilience.
    Though the resiliency training program, focusing on personal and psychological empowerment of physicians, temporarily improved the resiliency rates, it did not reduce the reported levels of fatigue among the participants.(2) Such resiliency methods in isolation do not seem to have a long-term benefits on the day-to-day practice in medicine. However, they may be handy even as a standalone strategy, in recharging the professionals in certain temporary situations like epidemic breakout, disaster scenario, warfare etc. Another drawback of repeated usage of resilience strategies is that it may render them ineffective with time, even in the same individual in whom the same strategies would work wonders earlier. In addition, repeated resiliency sessions could dilute the strive for perfection in medicine be...

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  • Re: [Medical research and audit skills training for undergraduates: An international analysis and student-focused needs assessment]

    Dear Sir,

    It was a pleasure reading Fitzgerald’s study on provision of research/audit opportunities and skills required to conduct such projects[1]. As medical-students, it was revealing to read statistics on how our contemporaries reported lack of formal research opportunities and training. As part of Europe’s largest medical school[2], one with a strong reputation that no doubt hinges on viable research output, we were not surprised by these results.

    Though we agree with the article’s conclusions, we’d like to offer our thoughts on factors affecting student output and improvements that could be made.

    From our experience, the main ways students are granted research opportunities are through Student Selected Components (SSCs) and intercalated BScs. Timescales for these are 5-6 months, with most having a shorter duration. Usually this is enough for a topic introduction, let alone information accumulation for an acceptable paper. Moreover, iBSc-derived research offers opportunities to access respected research teams and get better publications. We know students published in Nature due to their iBSc modules[3]. However, these modules are invariably oversubscribed, meaning students without sufficient marks are often excluded. Lastly, because of time and location demands on students during clinical years, it is likely most student publications come from research exposure during iBSc. The importance of this publication route needs further investigation....

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  • Response

    I was disappointed by this attempt to rebut my hypothesis.

    My hypothesis was not inchoate (OED “confused or incoherent”) as they obviously understood exactly what I wished to suggest – the conventional wisdom might be wrong or at least need some modification and that Carbon dioxide excretion may play a part in weight regulation.1

    We agree that the general public and health professionals are bewildered about weight regulation. That is not a reason to stop thinking and restate conventional wisdoms.

    We agree that “the majority of people they surveyed believed that that ”fat shed during weight loss was converted to energy rather than excreted as carbon dioxide and water.” That is not a reason to stop thinking and rely upon conventional wisdoms. I recall a paper that made the point that exhaled Carbon Dioxide might be relevant to fat loss.2 Indeed most people seem to assume that weight can be lost purely by energy production “raised metabolic rates” without a net excretion of heavy atoms but this is a conventional wisdom that is only correct in nuclear reactors in which E=mc2.

    Of course self –reporting of food intake is notoriously unreliable. But do we condemn as recidivists3 all those whose weigh loss plateaus on a diet? The same paper suggested a metabolic resistance to the maintenance of a reduced body weight. I merely provided a possible mechanism for this.

    We agree that “diets only succeed when the age-old advice to eat less and mov...

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  • Fake peer review: many faces

    Fake peer review: the many faces
    Viroj Wiwanitkit1
    1. Honorary Professor, Dr Dy Patil University, Pune Inida
    Email: wviroj@yahoo.com

    I read the recent publication by Cheung BMY with a great interest [1]. In fact, this problem is not uncommon and can be seen elsewhere.

    Reviews that seem overtly positive can be a clue for suspicious fake reviewing. It is the role of the journal editor to select the reviewer and consider the quality of the review. The fake reviewing might be by a non-existent (totally fake) person or a disguised reviewer. Sometimes, it can be a totally biased reviewer who is recommended by the submitting author.

    In addition, a similar problem can also be seen in academic presentations, proposal decisions, funding decisions, as well as academic position appointment decisions. In some underdeveloped countries, it is surprising that non-scientific reviewers can act as academic reviewers when academic work is under consideration. This reflects a poor standard and should be considered as an unacceptable misconduct.

    conflict of interest

    1. Cheung BMY. Fake peer review - too good to be true. Postgrad Med J. 2017 Jun 7. pii: postgradmedj-2016-134506.
    Conflict of Interest
    None declared

  • Re: [Verification and feedback for medical students: an observational study during general practice rotations]

    Dear Editor,

    It was with great pleasure that we read the observational study by Bosner et al [1] which centres on an aspect salient to all medical students: clinical teacher feedback [2][3][4]. A factor highlighted by Lempp et al, found that students were most pleased with teachers who were approachable and provided them with constructive criticism [4].

    As undergraduate medical students at the largest centre for healthcare education in Europe [5], we benefit from experiences in varied teaching settings; ranging from one-to-one sessions to class sizes of up to 450 students. Our clinical curriculum places strong emphasis in the primary health care setting - where we have accumulated nearly 300 hours between us in around 40 practices, both in and around London.

    Whilst Bosner et al [1] have presented a well-organised and structured study; we challenge some of the intricacies affecting its overall validity and subsequent conclusions, and therefore propose suggestions for improvements. There is an absence of information pertaining to whether the observers (fifth year medical students) were appropriately trained to effectively judge the quality of feedback given by their seniors (clinical teachers). This is then coupled with no mention of any guidelines or reference used as a “benchmark” for this assessment. Both present issues regarding quality assurance - the necessity and impact of which has been highlighted by Lievens [6].

    The presence of the ob...

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  • Gastric adenocarcinoma: the role of Helicobacter pylori in pathogenesis and prevention efforts.
    Shivani Saini

    The correct statement is as follows: The portion of the stomach within which H. pylori localises has profound impact on its clinical sequelae. H. pylori colonization of the antrum results in increased acid production which may lead to duodenal ulcer formation. On the other hand, infection within the body of the stomach predisposes individuals to atrophic gastritis, which, in turn, may progress to precancerous lesions a...

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  • Location of HPylori
    Bassem G Elgohary

    The article states: =======================================================The portion of the stomach within which H. pylori localises has profound impact on its clinical sequelae.18 H. pylori infection within the body of the stomach results in increased acid production and peptic ulcer disease. On the other hand, infection of the antrum predisposes individuals to atrophic gastritis, which, in turn, may progress to preca...

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  • Mobile phones are commonplace in Singapore
    Ching-Hui Sia

    Dear Editor,

    I read with interest the article titled "Mobile revolution: a requiem for bleeps?" by Martin et al. The authors state that 73% of people feel that traditional bleeps should be replaced with new mobile technologies. The authors also states the favourable attitudes hospital doctors have towards mobile technology.

    I would like to share the experience in our country. Singapore is a country in Sout...

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  • Storify relating to article
    Tejas Desai

    Author's Storify: https://storify.com/nephondemand/equal-work-for- unequal-pay-the-gender-reimbursemen

    In response to articles:

    American Council of Science and Health News: http://acsh.org/news/2016/08/17/medicare-supports-unequal-pay/

    Twitter comments: https://twitter.com/Skepticscalpel/status/767785871500251136

    Medscape: http://www.medscape.com/viewarticle/867652?src=rss


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  • Emphasis on Lifestyle Management Not Evidence Based
    Philip C Robinson

    I read with interest the manuscipt by Jeyaruban and colleagues. However I am disappointed that a major issue identified was a "Failure of adherence to lifestyle changes".

    There is scant evidence that lifestyle changes have any clinically relevant impact on gout management.

    Surgical weight loss is one of the few non medication related interventions that has a substantial impact on serum urate.

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